Cardiac devices and end-of-life care

Will my device keep my heart beating forever?

A pacemaker will not prevent you from dying. Usually, even in an end-of-life situation there is no need for further action with a pacemaker.

For an ICD, some considerations need to be taken into account. In the phase of dying, many patients experience ventricular arrhythmias – which would then be treated by an ICD. However, the initial goal of ICD therapy – prevention of sudden cardiac death – will no longer be maintained in this situation. ICD shocks can be painful for you and burdensome for the surrounding family. Therefore, in an end-of-life situation, you should discuss with your doctor deactivation of ICD therapies. Since this is not always predictable, you may discuss your will at a given time with your doctor and inform your family.

There are different functions, that can be activated/deactivated separately and which you can decide on on an individual basis:

• Pacemaker function
• ATP function (usually a painless method to terminate ventricular arrhythmias)
• ICD shocks
• Cardiac resynchronization therapy

What should I discuss with my family and my doctor?

Discuss your device’s functions and your personal preferences in a good condition with your doctor. Then inform the doctor and your family about how you want to proceed in an end-of-life situation. Write it down and tell your family where to find this writing.

Patient’s provision (living will): How should I phrase whether I want my device to be deactivated or not?

For writing your decree, be as precise for a specific situation you image, as you can be. If you need further information, re-discuss this with your doctor.
Possible points to include in your decree could be:

• I have a pacemaker/ICD.
• If I no longer should be able to give consent and I find myself in the process of dying/I am in the terminal stages of an incurable, fatal disease/even if the time of death cannot yet be foreseen… I dispose the deactivation of all ICD functions that are then no longer used to alleviate possible suffering or rather prolong my dying.
• Personally, it is important to me: …………………………

Cremation/burial

Usually, implants (teeth, prostheses etc.) remain in the body of the deceased. Pacemakers and ICDs are usually left before burial, too. However, some crematories require explantation of the devices before cremation due to the included battery. If this proceeding is of importance for you, talk to your local funeral home and your family to communicate your personal wishes.

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FREQUENTLY ASKED QUESTIONS

Can you still die with a pacemaker or ICD?

Yes, a pacemaker or ICD does not prevent death from conditions unrelated to arrhythmias. While these devices help manage heart rhythm problems, they cannot stop the progression of severe heart failure or other terminal illnesses.

Does a pacemaker keep working after death?

Yes, pacemakers may continue sending electrical signals even after death, as they are not designed to recognize when a person has passed. This does not affect end-of-life processes.

How is a pacemaker deactivated at the end of life?

Pacemakers can be deactivated through a non-invasive process using a specialized magnet or programming device, typically performed by a healthcare professional.

Will an ICD deliver shocks during end-of-life care?

Yes, unless deactivated, an ICD may deliver shocks if it detects arrhythmias. Many patients choose to deactivate the ICD during hospice care to avoid discomfort.

How does a pacemaker function when someone is dying?

A pacemaker will continue pacing the heart but cannot overcome advanced organ failure or other causes of death. It ensures heartbeats are regulated until natural processes take over.

Should pacemakers or ICDs be turned off during end-of-life care?

Deactivating these devices is a personal decision made with the patient, family, and healthcare team, often to align with the patient’s comfort and care goals.